Question 21683 — bioethics

Summary

Ms. Valérie Boyer questions the Minister of Solidarity and Health on the consequences of opening medically assisted procreation to all women. The principle of dignity occupies an eminent place among the socially protected values ​​and in the hierarchy of norms. Because if, as Immanuel Kant put it, “what has a price can just as easily be replaced by something else in an equivalent capacity; on the contrary, what is superior at all costs, that which admits of no equivalent, is that which has dignity.” It is up to the legislator to ensure that this principle is strictly respected, in the face of societal and medical developments, including when the temptation to deviate from it is driven by laudable intentions. This is the case when the conception of a child is in question. Some couples, who cannot have one on their own, either because of the woman's infertility preventing her from carrying the child, or because they are same-sex couples, take circuitous routes to achieve this. Without much surprise, the National Consultative Ethics Committee (CCNE) issued a favorable opinion on access to PMA for all women, as it had already done in July 2017. However, there is no consensus on the question of extending PMA. Indeed, as the recalls the CCNE, “in particular on the consequences for the child of an institutionalization of the absence of a father, therefore of the absence of the “masculine-feminine” otherness in the diversity of his psychological construction, but also on the possible increased risks of commodification of the human body. Indeed, this request for opening must be confronted with the current scarcity of gametes which risks causing an extension of deadlines waiting or a break in the principle of free donations. This could open up prospects for the commodification of human body products and call into question the French health system based on altruistic principles. These debates had also led and still lead today a minority of CCNE members to propose, within the framework of opinion 126, that in this area the status quo be maintained. The participants at the general meetings of bioethics also declared themselves very reserved on the extension of the PMA. More than 80% of participants in regional events were against it, and up to 89.7% of written contributions on the website. This opinion cannot obscure the dangerous consequences of such an expansion of PMA which consecrates a real right to the child and in particular leaves the field open to legalization of GPA. in the near future. This expanded PMA therefore poses numerous ethical difficulties that should not be ignored. It must be remembered that PMA is a set of medical techniques available to all couples suffering from a pathology of sterility or having a risk of transmitting a particularly serious disease. There is no discrimination with regard to PMA: all couples with a medical problem noted there have access. In this case, if single women or couples of women cannot have a child, it is not because of a medical problem. The desire to have a child would be an abuse: it would be a misuse of medicine for the benefit of societal demands. Its financing implies a major incompatibility with social security which bases its action on the principle of solidarity, on aid to the most vulnerable, not allowing the reimbursement of medical procedures only if they correspond to a case of illness. It is estimated today that the average cost of in vitro fertilization (IVF) in France is 4,100 euros, which includes treatments, egg retrieval, hospitalization, and the procedures themselves. It is on these rates that social security today reimburses those who are entitled to it. But it is important to specify that this amount does not takes into account neither work stoppages (three days minimum, five to seven most often), nor additional costs incurred during the process by the establishments (reception, organization, staff). According to health insurance figures, 288 million euros were spent in this way in 2014, the year when 102,601 attempts at artificial insemination, IVF or frozen embryo transfers were counted. Two years later, in 2016, the figure rose to 147,730. PMA used for purposes other than medicine would also open the way to a very lucrative business, such as with reproductive clinics in Spain, Belgium and elsewhere. The IVI clinic in Spain, for example, makes commercial offers in terms of medically assisted procreation. “With IVI Baby, you will have your baby at home within a maximum of 24 months,” can we read on their website, even establishing a “satisfied or refunded” principle. Is this what the French want in their society? Furthermore, in France, only a few hundred men (255 in 2015) undertake the process of donating gametes, in this case sperm, each year. However, despite this particularly low figure, the CCNE gives a favorable opinion on the extension of PMA to all women and also speaks in favor of lifting the anonymity of donors. In its practical application, the expansion of the PMA therefore suggests a possible shortage of sperm donations, with the temptation of remuneration of donors thus breaking with the principle of non-commodification of the human body. According to the Biomedicine Agency, there is currently a shortage of 300 sperm donations per year to be able to respond to all requests from couples infertile. Therefore, to have access to a donation, you must wait between 13 and 24 months. If the legislation changes, this risks lengthening waiting times. The CCNE places as a condition for the extension of the PMA the diffusion of “energetic campaigns, repeated over time”. What does this mean? That campaigns would suddenly become 10, 20, 30 times more effective? That we're going to put the pressure on until we get what the interested do not want to do? This is neither serious nor credible. So how do other countries do it, the few that have extended PMA to single women and couples of women? Unfortunately, the fact is that they do not escape the gamete trade. Indeed, either States have made gametes chargeable, like Spain and Denmark; or they buy abroad, in countries where the gametes are remunerated. In Belgium for example, in 90% of cases, the sperm come from Denmark. Great Britain thus publicly explained, on August 31, 2018, that if the Brexit agreements did not also include PMA, it would be faced with a shortage of gametes because it would not be able to continue to buy them from other countries. In passing, she clarified that she buys almost 50% of her sperm samples in Denmark. If the legislator makes this a reality, the current shortage could “get worse”, recognizes Jean-François Delfraissy, president of CCNE. Extending PMA means increasing the need for sperm supply, which leads, whether we like it or not, to the trade in gametes. However, the CCNE itself emphasizes that “once the principle of free access to gametes is broken, it is difficult to see what would prevent the same thing from being done for other products and elements of the human body, including organs ( ). There is, as the international market for blood and its derivatives, gametes, or surrogate mothers shows, an immense pool of people who, because of their economic difficulties, agree to sell the elements of their body. And to add that this point “can neither be dismissed nor minimized”. This point is fundamental and we must not be naive: if it extends PMA to women who are fertile but have therefore systematically need sperm supply, France will participate in the international gamete trade. And as the CCNE itself says, it will then be the other elements of the human body which will be concerned. It also seems inconsistent and contradictory to assert that we can establish on the one hand PMA for couples of women, and on the other hand continue to prohibit surrogacy (GPA) for couples of men wishing access fatherhood and who sometimes live with the same suffering. Why would we implement a right to a child for women, but not for men? Sooner or later, on the grounds of equality, GPA would also be legalized. Some retort that this has nothing to do with it because surrogacy is unacceptable because of the exploitation of women it involves. But we should no longer be naive: if we are ready to deny the fact that children need a father, tomorrow we will deny the fact that women are exploited within the framework of surrogacy. Like the journalist Marc-Olivier Fogiel, we will claim that “women find fulfillment by giving up their child”! This desire to have a child may be legitimate, but this expansion of PMA would be an immense anthropological leap. Thus, it is opening “Pandora’s box” of transhumanist logic: increasing the possibilities human rights through the use of all possible techniques under various pretexts (primacy of the right to the child, disease prevention, performance). More than ever, we must be extra vigilant in the face of the enlargement of the PMA, which suggests large-scale upheavals. If we draw this “red thread”, it is the ethical and solidarity values ​​that we unravel to the point of compromising the French system of protection against unacceptable excesses. She wishes to obtain answers to all of these questions, particularly ethical ones.

Machine translation from French. The official text remains authoritative.

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